九种常用敷料治疗糖尿病足效果的网状Meta分析  

Effects of Nine Different Dressings in the Treatment of Diabetic Foot:A Network Meta-analysis

作　　者：侯宇颖[1] 张志刚[2] 张珺[3] 张菊霞 王波[5] 杨爱玲[6] 田金徽[7] 

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]兰州大学第一医院重症医学科,兰州730000 [3]甘肃中医药大学护理学院,兰州730000 [4]甘肃省人民医院护理部,兰州730000 [5]甘肃省康复中心医院护理部,兰州730000 [6]兰州大学第二医院护理部,兰州730000 [7]兰州大学循证医学中心,兰州730000

出　　处：《中国循证医学杂志》2016年第11期1291-1297,共7页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价9种不同敷料治疗糖尿病足(DF)的效果。方法计算机检索Pub Med、The Cochrane Library(2016年第2期)、Web of Science、EMbase,中国生物医学文献数据库(CBM)、中国学术期刊网络出版总库(CNKI)、万方数据期刊论文资源数据库中关于不同敷料治疗糖尿病足的随机对照试验(RCT),检索时间均为建库至2016年4月。由2名研究者独立进行文献筛选、资料提取并评价纳入研究的偏倚风险后,采用Win Bugs 1.4.3和Stata 13.0软件进行数据分析。结果最终纳入29个RCT,共2 393名患者。网状Meta分析结果显示,银离子敷料优于藻酸盐敷料、凝胶敷料、蜂蜜敷料、无菌纱布、碘伏纱布,藻酸盐敷料优于无菌纱布、碘伏纱布,凝胶敷料优于碘伏纱布,蜂蜜敷料优于无菌纱布、碘伏纱布,泡沫敷料优于银离子敷料、藻酸盐敷料、凝胶敷料、蜂蜜敷料、无菌纱布、碘伏纱布、抗菌药物纱布,壳聚糖敷料优于凝胶敷料、无菌纱布、碘伏纱布,抗菌药物纱布优于无菌纱布、碘伏纱布;差异均具有统计学意义。根据累积排序概率曲线下面积(SUCRA)排序结果,泡沫敷料、壳聚糖敷料是治疗糖尿病足的较优方案。结论基于网状Meta分析结果和SUCRA排序结果,泡沫敷料和壳聚糖敷料治疗糖尿病足的效果优于其他敷料。未来研究应关注不同种类敷料间效果的直接比较及成本效果评价。Objective To systematically evaluate the effects of nine different dressings in the treatment of diabetic foot （DF）. Methods Databases including PubMed, The Cochrane Library （Issue 2, 2016）, Web of Science, EMbase, CBM, CNKI and WanFang Data were searched to collect randomized control trials （RCTs） about the effects of dressings for the DF from inception to April 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then network meta-analysis was performed using WinBugs 1.4.3 and Stata 13.0 softwares. Results A total of 29 RCTs involving 2 393 patients were included. The network meta-analysis showed that silver ion was superior to alginate, hydrogel, honey, sterile gauze and povidone-iodine gauze; Alginate was superior to sterile gauze and povidone-iodine gauze; Hydrogel was superior to povidone-iodine gauze; Honey was superior to sterile gauze and povidone-iodine gauze; Foam was superior to silver ion, alginate, hydrogel, honey, sterile gauze, povidone-iodine gauze and antibacterials gauze; Chitosan was superior to hydrogel, sterile gauze and povidone-iodine gauze; Antibacterials gauze was superior to sterile gauze and povidone-iodine gauze. All of the differences were statistically significant. Probability ranking according to SUCRA showed that there was a great possibility for foam and chitosan in the treatment of DF. Conclusion Based on the results of network meta-analysis and rank, foam dressing and chitosan dressing are superior to other dressings in the treatment of DF. More attentions should be made regarding comparisons directly of different dressing and reporting of cost-effective analysis.

关 键 词：敷料 糖尿病足 随机对照试验 网状Meta分析 

分 类 号：R587.2[医药卫生—内分泌]